August 16, 2005

Sure, I'll keep it private!

I'll publish it in the New York Times, but other than that I'll keep it private.

30 comments:

Paul said...

Yes, imagine if he sees the article, at that age he'll just know that everyone knows and avert his eyes, waiting to be greeted with laughter. Oh well, the price of fame.

leeontheroad said...

right, Paul, but every thirteen year-old patient who reads the NYT today will think it's him!

Steven Taylor said...

Well, as the whole nannyblogger incident taught us, you an write about in the NYT so long as you don't blog it, for goodnesssake.

Bruce Hayden said...

Totally missing your point, I thought that the article was quite cute. I can think of some other effects of a couple of cans of Mtn. Dew besides what he asked about. The caffine in them would be scary.

Ann Althouse said...

Well, Bruce, imagine if the doctor had fully disclosed to the boy: I won't tell anyone you specifically said something, but I will use your statements to write articles that are widely punished, and I'll be especially likely to quote you if your question is embarrassing, so go ahead. Would the boy have spoken?

Bruce Hayden said...

He asked whether his sperm count would go down if he drank a lot of Mtn. Dew - kinda like cheap birth control.

But this reminds me of a slightly OT story from college. Two senior pre-meds shacked up (I think Ann's class in college). She gets pregnant, has an abortion. He assures her that she can't get pregnant immediately after another pregnancy. She gets pregnant again immediately. Another abortion. She starts med school about 6 months later, and is now on the other side of this, answering questions like this from kids like him every day.

Bruce Hayden said...

Ann,

No, of course not. But we really don't know how long ago this was. Yes, it is written almost as if it happened yesterday. But that is as likely a literary device. And if it happened, say 20 years ago, and he now has kids this age, he would probably think it quite humorous.

Ann Althouse said...

And of course kids say "cute" things all the time, but maybe we ought to hesitate before exploiting their innocent cuteness.

Bruce Hayden said...

Or, maybe, it is that I would, if it had been I twenty years ago asking this.

OTH, the Mountain Dew may indicate that it is more current. I don't know how popular it was back then with this age group.

Bruce Hayden said...

One last thought. How likely is it that a 13 year old is reading this part of the NYT? Probably only if his parents have put a gun to his head (figuratively, not literally).

My daughter just left being 13, and getting her to read anything in the paper besides the comics is nearly impossible. I end up bribing her to read a page or so (of her choice) of the WSJ or The Economist - and she loves to read. Just not serious adult type stuff.

Bruce Hayden said...

Ann,

I agree too with your statement about exploitation. Sorry if I am playing too much the devil's advocate - a result of what you do for a living (i.e. law school).

ploopusgirl said...

Or maybe you should just lighten up, Ann. No one's being exploited here. The boy probably doesn't read the New York Times' Health section at thirteen. Even if he does, his name is never mentioned, and I'm not quite sure that all thirteen year olds are so paranoid as to think that everyone he knows will think that the random thirteen year old boy in the article is him. You're reading WAY too much into this.

Kat Coble said...

. No one's being exploited here. The boy probably doesn't read the New York Times' Health section at thirteen.

The victim of exploitation doesn't have to be aware of it for exploitation to exist. I sleep nude. (I'm going somewhere with this...)

In college my roomate sold tickets to guys on campus to view my soundly-sleeping naked body. Our dorm was in the basement, and our window was ground level. I wasn't aware of this nightly bit of fun for several weeks. Would you say that I was still exploited? Yep.

Same with this boy. He placed his trust in this physician. Regardless of hiis daily reading habits, she still violated that trust.

ploopusgirl said...

No, Mycro, he hasn't been. The physician never mentions his name. At the mention of his name, she would be entirely in the wrong and clearly exploiting him. Well, at that point it would be illegal as well, and her liscence would be in severe jeopardy. However, his name is not mentioned. Physicians regularly publish anonymous accounts of experiences with their patients in newspaper health sections and in medical journals. This is not as big a deal as Ann, and you apparently, would want to make it out to be.

Goesh said...

Any herbalist worth his salt would have told the boy the same thing the good doctor did - I see nary a comment on patient/doctor repoire, which I think is often lacking these days. AND, any herbalist worth his salt can see that Poopusgirl has been ingesting too much Stinging Nettle.
All I can say is maybe some Health teacher can use this article to dispel some myths young people have about their bodies.

ploopusgirl said...

Goesh: Why don't you grow the hell up already? Maybe your belief that you can substitute an herbalist for a real physician has made you the moron you are today, eh?

Goesh said...

Well! I have never advocated replacing a physician with an herbalist. I have stated that certain herbs are indeed beneficial and have more efficacy than standard medications. If you want to play hard ball, so be it. I won't then suggest a remedy for the chronic constipation you appear to be plagued with.

Joan said...

I think Ann needs to read more medblogs.

The likelihood is that this article is based on several actual conversations, and is an amalgam of experiences. The author has probably had those same questions asked, and seen that same flustered embarrassment, from dozens if not hundreds of patients.

There is no violation here. I do think that it would have been better to include a disclaimer at the end of the article, as many medblogs do, that the anecdotes related therein do not refer to any particular patient, but do truthfully represent the type of exchanges the doctor has with these young people.

Was that a Freudian slip, or did you really mean to say "widely punished"!?

Jonathan said...

Interesting questions. Before the Internet the physician's trust violation, which is what this appears to be (especially if we assume that he examined the boy recently), would have been of less consequence. His account of the boy's question would have been published in one daily edition of one newspaper, and then it would, for practical purposes, disappear. It would have been very unlikely that anyone could identify the boy. Nowadays there seems to be more potential for harm, as identification is a real possibility (never mind that any harm in this case would probably be minor).

The physician seems to have framed this situation not as a promise to be kept but as a utilitarian question of whether the benefit from publishing the boy's question outweighs any potential costs that the boy might incur if he were identified. The physician also seems, as Ann points out, to have ignored the principle of informed consent.

The physician's behavior might be justifiable if you think physicians should act to maximize some notion of the greater good. However, his behavior was inappropriate if you think physicians are providers of services to individuals, are bound by contracts (e.g., my word is my bond) and should be discreet.

These criticisms probably don't apply if the physician's story was, as the previous commenter suggests, a composite of multiple experiences with multiple patients. But if that was the case there should have been a disclaimer.

knoxgirl said...

"Regularly, I embarrass my own children. I tell stories that they view as mildly (or not so mildly) inappropriate, or I use words they feel should not be used in polite company."

nice!

Walter said...

I thought Ann's take was a funny juxiposition. The doctor promised not to tell anyone and then wrote about what the 13-old said in her office in a widely read paper. I hate to admin it, but I think p[l]oopusgirl is right, the doctor didn't do anything wrong. But p[l]oopusgirl should lighten up a bit in these comment forums.

Ann Althouse said...

Thanks, Walter. I think it's interesting how the comments have fixed on the concept of a "violation."

Do I need to read more medblogs? The assumption there is that the doctors' ideas about ethics are what matters. But why? Maybe I have a stronger idea of what duties we owe to minors. There are higher concepts of morality that we might want to consider.

I wouldn't write an essay or a blog post quoting something a student said that I thought my readers might enjoy laughing at. I wouldn't think withholding the name would be enough — or making a composite quote.

Joan said...

I think if you read more medblogs, you'd see that this type of anecdote is quite common in writing that doctors do for public consumption. As I said before, typically a disclaimer will be included. But in a discussion such as this one, wherein no unique identifiers are present which could identify an individual patient, I don't think the lack of disclaimer makes this an ethical violation. Health care privacy is very big deal since HIPAA, and I doubt that either the author of the piece or the editors of the NY Times failed to consider whether or not the contents of the article were sufficiently generic enough so as to avoid identifying a particular patient.

Researchers also routinely reveal the results of anonymous surveys, including comments that people make on the issues being examined. The people making these comments are assured of their privacy; when the comments are made public, they are done so without attribution. Are researchers who report data like that also committing an ethical violation?

Kathy Herrmann said...

"Most of the time, the adolescents just shake their heads. No questions."

Well no wonder since here's a prime example of an adult promising trust and then violating it in a public newspaper for a story that meant to be humorous entertainment as much as it is a learning vehicle for other adults.

I agree with Ann on this one and think most commenters saying no big deal are looking at this as a physician writing in a scholarly journal rather than a public newspaper.

You can't assume the teenager might not read the paper. Some do.

And it doesn't matter if the boy's identity is shielded. Even if no one else in the world could connect the boy to his question, he'd know the physician violated his trust.

Jonathan said...

Joan wrote:
Researchers also routinely reveal the results of anonymous surveys, including comments that people make on the issues being examined. The people making these comments are assured of their privacy; when the comments are made public, they are done so without attribution. Are researchers who report data like that also committing an ethical violation?

A survey or test disclosure form typically includes a description of exactly what the investigators will do with the data, i.e., whether they will publish aggregate or otherwise personally unattributable results. So the subjects know ahead of time exactly what will happen and are free not to participate. There is no ambiguity. By contrast, in the case that is the subject of this post, the physician did not tell the patient that his story might be published without attribution. That is the critical difference that makes the physician's conduct unethical. The physician could have told the kid exactly what he might do with any information. Instead, he promised secrecy, in a way that suggests he anticipated the boy would misinterpret what he meant by "secrecy," and that suggests he expected a "no" answer if he had been honest.

Shouldn't the physician, as the knowledgeable and authoritative (and in this case, adult) party try to dispel ambiguity in such cases, and shouldn't he also put the patient's agenda ahead of his own?

Joan said...

According to Jonathon, every medblogger who writes a story based in anyway on patient interaction is violating that patients' trust.

I disagree -- but I'm going to blog on this issue and submit it to the next Grand Rounds and see what the medbloggers think. I think this topic could use some input from those in the medical profession who routinely deal with this kind of ethical situation.

ploopusgirl said...

Joan: I think I love you. I love when someone who actually knows what they're talking about shuts these fools up. ;)

Jonathan said...

Joan wrote:
According to Jonathon, every medblogger who writes a story based in anyway on patient interaction is violating that patients' trust.

I think that you are missing the point. I do not oppose disclosure of patient information as long as the patient doesn't mind. In this particular case, it seems reasonable to assume that the child patient did indeed mind, since he went out of his way to indicate that he wanted his case to be kept private. By interpreting "private" in a way that advanced his own agenda, the physician put himself ahead of the patient and indeed showed contempt for the patient's wishes. That's not how physicians should behave.

I don't know about you, but if I asked a physician to be discrete about our interaction I would expect him not to write about me in a public forum, even if he didn't disclose my name. If there were any doubt about my intentions, the physician could always ask my permission before he published. Maybe he has not obligation to do so, but I would consider it a breach of trust if he did not.

Joan said...

Jonathon wrote: I do not oppose disclosure of patient information as long as the patient doesn't mind.

Let's call the patient and ask him if he thinks the doctor violated his trust. Should be easy to do. At least Jonathon seems to think so.

Joan said...

My post, the anonymous patient has been submitted to Grand Rounds for next week. Stay tuned!